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Bethesda, MD -- A new
Health Policy Brief from Health Affairs and the
Robert Wood Johnson Foundation looks at efforts to improve care
transitions. These are the movements that patients make among
health care providers and settings as their needs change during
the course of illness--for example, from a hospital to a nursing
home, and sometimes back again. If these transitions aren't
carefully coordinated, they can result in harm to patients and
waste money. Researchers estimated that in 2011, poor transitions
caused between $25 and $45 billion in wasteful medical spending
through avoidable complications and unnecessary hospital readmissions.
Topics covered in the brief include:
- The causes of poor care transitions. One major
factor is the lack of communication between the hospital and
the patient's regular outpatient provider. For example, often
a hospital will not forward a patient's records back to a
primary care physician, so the doctor won't know that the
patient needs follow-up care. And patients frequently don't
understand discharge plans--such as medication instructions--given
to them at the hospital.
- Improving care transitions. The policy brief describes
several models for improving care transitions, including the
introduction of patient coaches to help patients manage medications,
schedule appointments, and respond to medical "red flags,"
including fever or shortness of breath. The Affordable Care
Act also contains a number of relevant provisions. For example,
hospitals can receive increases to their Medicare payments
if they meet or exceed performance targets for quality measures,
such as asking patients if they have the help they need at
home. And the quality metrics that must be met by accountable
care organizations to benefit financially under the Medicare
Shared Savings Program include six that pertain to care coordination,
including preventing unnecessary hospital readmissions.
- Other policy options. If such measures don't succeed
in improving care transitions, the Centers for Medicare and
Medicaid Services' statutory authority provides additional
options, including using a newly created billing code that
would enable physicians to bill for delivery of care transition
services. Other policy options include adding a care transitions
measure to Medicare's Hospital Inpatient Quality Reporting
Program and further limiting payments for certain hospital
readmissions.
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Health Affairs is the leading journal at the intersection
of health, health care, and policy. Published by Project HOPE, the
peer-reviewed journal appears each month in print, with additional
Web First papers published periodically and health
policy briefs published twice monthly at www.healthaffairs.org.
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Affairs Blog.
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